Policies need to be reviewed carefully
to determine whether the benefits
cover "actual or reasonable expenses"
or if they are limited to a specific
dollar amounts. The differences between
actual, reasonable or scheduled dollar
expenses can be quite large. Review
the insurer's schedule of "allowable
charges" and compare it to other
local providers to see if it is similiar.
For example, is the policy reasonable
in its estimates of various healthcare
costs in your area. If the policy
only pays up to $300 for a specific
treatment when it will cost 10 times
that amount ... maybe the policy isn't
the best for your group.
Most insurance policies
do not provide coverage for experimental
procedures. For example, organ transplants
usually fall under the category as
"experimental". So find
out if transplants are covered and
what "exclusions" there
are for various health services and
procedures.
After buying a group
healthcare policy, employers need
to make sure that the employees understand
the benefits of the plan. Also, they
need to be made aware of their responsibilities
associated with the policy.
Beware of Fraudulent
Health Insurance Plans
In many states, there
are an increasing number of unlicensed
insurance companies attempting to
sell fraudulent health insurance plans.
These plans often falsely claim to
have affiliation with known health
insurance companies or be self-funded
employee or union plans. Investigate
any suspicious health plans and be
certain that they are licensed in
your state. Your state has a insurance
department that can be contacted for
verification.
READ:
Beware of Fraudulent Group Health
Insurance Plans
